Healthcare Provider Details

I. General information

NPI: 1861566127
Provider Name (Legal Business Name): LISA VENDITTI R.PH., CGP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 JAMES CT
MAHOPAC NY
10541-3091
US

IV. Provider business mailing address

17 JAMES CT
MAHOPAC NY
10541-3091
US

V. Phone/Fax

Practice location:
  • Phone: 845-208-3328
  • Fax: 845-208-3328
Mailing address:
  • Phone: 845-208-3328
  • Fax: 845-208-3328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number035315
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number035315
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: